OMAHA -- Lana Brodersen was just about to crawl into bed in her camper around 11 p.m. June 11 when she broke out in hives from head to toe.
Her husband, Brodie Brodersen, drove her the roughly 10 minutes from their campsite west of Fremont to Methodist Fremont Health. She made it through the first set of double doors to the emergency room but collapsed before she could get through the second pair.
She later learned that she had gone into anaphylactic shock, a severe allergic reaction that can be deadly if not treated quickly.
The hospital emergency room staff questioned her thoroughly: Had she taken any new medications? Eaten anything different?
No. And Brodersen, 61, of Fremont, had no known allergies.
When she fell, Brodersen hit her head and broke a vertebrae in her neck, so the emergency staff in Fremont sent her to the Nebraska Medical Center in Omaha for further treatment of that injury.
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There, her son, his wife and Brodersen’s stepdaughter mentioned an article they had read about alpha-gal syndrome, an allergy to red meat triggered by the bite of a tick. In the U.S., it’s associated with the lone star tick. The tick’s range has expanded in recent years, in part because of climate change, and now includes part of eastern Nebraska and much of Iowa.
A key feature of the allergy is a delayed reaction to meat or dairy products, typically two to six hours later, according to the federal Centers for Disease Control and Prevention. Reactions vary from person to person. Other symptoms can include hives or an itchy rash; nausea, vomiting and diarrhea; a cough; shortness of breath; and difficulty breathing.
Brodersen had eaten a hamburger about four hours before she broke out in hives. In early May, she had been bitten by four ticks while out mushroom hunting. Afterward, she developed a rash on her belly. She later learned a rash can be an early sign of the condition. She had also had an eye infection, another symptom cited by alpha-gal allergy sufferers.
At her children’s urging, she made an appointment with Dr. Brian Kelly, an allergist and immunologist with Midwest Allergy and Asthma Clinic.
A blood test detected antibodies known as immunoglobulin E, or IgE, to the alpha-gal sugar, formally known as galactose-alpha-1,3-galactose. It’s found in most mammals, but not in birds, fish, reptiles or humans. The positive test, and Brodersen’s history of tick bites, Kelly said, confirmed that she has the syndrome.
“I’m really happy to know what caused it,” Brodersen said. “It sucks that that’s what it is, but at least now I don’t have to keep wondering, ‘My God, what was it.’ Because the doctor said, a couple more minutes, I never would have survived. And my husband and I had no idea I was in a life-threatening situation. I just thought I had hives everywhere, and I knew I was miserable. It just hit in a matter of a couple of minutes.”
Brodersen no longer will be able to have the greasy cheeseburgers she loves. When she cooks a steak or burger for her husband, she makes sure her source of protein — now chicken or fish — doesn’t come in contact with his. She acknowledges the irony of her new diet: Brodersen is the human resources manager at Fremont Beef Co., where she has worked for 32 years.
Brodersen also carries an EpiPen wherever she goes.
“I’m just tickled that my kids had just read about (alpha-gal syndrome) or none of us would have known what to do,” she said. “And I definitely would have had another attack, because I would still (have) had my cheeseburger.”
Dr. Michele Williams, emergency director at Methodist Fremont Health, said anaphylactic shock is serious and time-sensitive. A person who experiences new or unusual reactions such as significant hives or hives combined with other symptoms such as facial swelling, breathing difficulty, lightheadedness or nausea and vomiting should seek immediate care.
Kelly said the tick is thought to deliver the alpha-gal sugar when it bites. A subsequent exposure to the sugar after, say, eating a hamburger, produces the acute reaction.
Not everyone who is bitten by a lone star tick will develop the allergy, so far as researchers know, he said, so it is considered rare. Much is not yet known about the condition, although researchers are studying it. The allergy has been identified in other countries, so it may be associated with other ticks.
“We don’t know how often a tick bite is going to turn into alpha-gal syndrome,” Kelly said.
People should be aware that the condition exists, he said, but they should not be afraid to eat red meat. Nor should they assume they will develop the allergy if they are bitten by a tick. Kelly said he has seen at least a couple of other cases, but only in the last few years.
“I don’t want to alarm anybody,” Kelly said. “I don’t think it’s a widespread public health issue ... because it’s quite rare. But it’s something we should be learning more and more about as the range of the lone star tick expands.”
Roberto Cortinas of the University of Nebraska School of Veterinary Medicine and Biomedical Sciences said ticks always are moving into new areas. But when winters were harsher, they didn’t survive the colder months and didn’t establish a presence.
The lone star, so named for the white dot on adult females’ backs, used to be a southern species. Now Cortinas’ colleagues in Canada are seeing them.
Other ticks, too, have expanded their reaches. Established populations of black-legged ticks, which can carry Lyme disease, first were identified in Douglas, Sarpy and Saunders counties in 2019. Last year, testing confirmed Lyme disease in black-legged ticks in Nebraska for the first time after the Northeast Nebraska Public Health Department determined that two cases of Lyme disease were contracted within its jurisdiction. Both patients reported likely exposure around the same time at sites near each other in Thurston County.
“It’s all very dynamic now, as far as distribution,” Cortinas said.
Just how often alpha-gal syndrome occurs, however, isn’t clear. Health care workers are not required to report it to state or federal health agencies, Cortinas said. According to a 2021 paper, more than 34,000 people in the United States have tested positive for the syndrome.
Kelly said people who find a tick should remove it. They also can take a photo to show their doctor in order to identify it. If they eat meat and experience symptoms of an allergic reaction, they should seek medical help immediately in case it’s not just a minor reaction.
Otherwise, people heading outdoors should take the usual precautions: using an insect repellent with at least 20% DEET, picaridin or IR3535, or wearing permethrine-treated clothing; avoiding grassy areas and wearing long-sleeved shirts, pants, socks and close-toed shoes while in tick habitat; checking for ticks on their body, clothing and pets when returning indoors; and showering within two hours of being in those areas.
As for those who develop alpha-gal syndrome, there are no treatments for now, Kelly said. Avoiding mammalian meat is key. About 5% of people with the condition may have issues with dairy, so allergists don’t routinely recommend that people avoid it unless something suggests it might be a concern. The same goes for gelatin-based products, which can be problematic for some.
Kelly said there’s some indication the allergy can go away after a time, although little data is available explaining how that happens or how often it occurs. He does have one former patient with the allergy who moved to North Carolina and successfully completed a supervised beef challenge with another allergist.
“I think this will be a much better understood disease process with time,” he said.